Introduction Transnasal upper GI endoscopy (TN-OGD) minimises stimulation of the pharyngeal reflex by eliminating tongue contact; this contrasts with conventional (oral) upper GI endoscopy (C-OGD) which uses the root of the tongue as a fulcrum for insertion and withdrawal. TN-OGD is a promising alternative to C-OGD in view of its potential to improve patient experience and obviate the need for sedation. SCENT (St Mark's Conventional Endoscopy vs trans-Nasal endoscopy Trial) is the first prospective, randomised head-to-head trial of TN-OGD vs C-OGD in a UK cohort.
Methods Evaluation of patient experience, feasibility, safety and diagnostic capability of TN-OGD as compared to C-OGD in a UK setting. 200 patients fulfilling the study criteria were randomised to TN-OGD or C-OGD. Standard (10 cm) visual analogue scales (VAS) and Likert (5 point) scales were used. Patient safety was assessed by recording vital parameters during and post-procedure. Doses of sedation and topical anaesthetic, duration of patient preparation and procedure and recovery times were documented. Endoscopic views of each procedure were digitally recorded for evaluation of diagnostic capability by a panel of expert endoscopists.
Results The final analyses of data from SCENT demonstrate significant differences between TN-OGD (n=94) and C-OGD (n=106) groups. VAS scores for overall patient discomfort (higher score = greater discomfort) were significantly lower in the TN-OGD group compared to the C-OGD group (1.8 vs 4.0, respectively, p<0.001). VAS discomfort scores for TN-OGD were also significantly lower than VAS scores for C-OGD done with a slim endoscope (1.9 vs 3.2, respectively, p=0.001). Mean patient preparation time was longer for TN-OGD than for C-OGD (5.5 vs 4.6 min, respectively, p<0.001). Procedure duration was also longer for TN-OGD than for C-OGD (10.0 vs 7.0 min, respectively, p=0.004) but recovery times after TN-OGD compared to C-OGD were significantly shorter (5.0 vs 10.0 min, respectively, p<0.001). There was no significant difference between the overall diagnostic capability VAS for TN-OGD and C-OGD scores (8.9 vs 9.1, respectively, p=0.47).
Conclusion The final analysis of SCENT supports the findings of previously reported studies and suggests that TN-OGD is feasible, more comfortable for patients than C-OGD, avoids the need for sedation and reduces recovery time. The results also suggest that it is the TN route and not just the endoscope diameter that makes the procedure more comfortable for patients.
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